Hyperparathyroidism is a disease that causes the overproduction of the hormone PTH, released by the parathyroid glands, which are located in the neck behind the thyroid.
The hormone PTH helps to maintain calcium levels in the blood and, for this, its main effects include the reabsorption of calcium in the kidneys, a greater absorption of calcium from food in the intestine, as well as the removal of calcium stored in the bones to release into the bloodstream.
Hyperparathyroidism can arise in 3 ways:
- Primary hyperparathyroidism: it happens when a disease of the parathyroid glands themselves causes a hypersecretion of the hormone PTH, mainly due to an adenoma or hyperplasia of these glands; Secondary hyperparathyroidism: arises due to a disturbance in the body's metabolism, which stimulates parathyroid glands, especially due to kidney failure, and which causes decreased levels of calcium and phosphorus in the circulation; Tertiary hyperparathyroidism: it is more rare, it is characterized when the parathyroid glands secrete more PTH on their own, and can appear after some time of secondary hyperparathyroidism, for example.
When identified, hyperparathyroidism needs to be promptly treated, as it can have negative consequences, such as weakening of the bones, increasing the risk of fractures. In addition, excess calcium in the blood can also cause changes in the functioning of muscles, kidney stones, increased blood pressure and other cardiovascular problems.
This disease is curable when surgery is done to remove the gland, however, before that, remedies that can be used to control symptoms can be indicated.
Main symptoms
Some of the most common signs and symptoms in cases of hyperparathyroidism are:
- Fragile bone with a higher risk of fractures; Muscle weakness; Development of kidney stones; Increased urge to urinate; Constant pain in the belly; Excessive tiredness; Development of renal failure or pancreatitis; Nausea, vomiting and loss of appetite.
Hyperparathyroidism does not always cause symptoms, especially in the early stages, so it is common for this disease to be identified in routine blood tests, which shows changes in blood calcium levels.
How to diagnose
The diagnosis of hyperparathyroidism is made by measuring the hormone PTH, which is increased in all types of the disease. Then, the endocrinologist will order other tests that help to identify the cause of the problem, such as calcium dosage, which is high in primary hyperparathyroidism and reduced in secondary, in addition to tests such as calcium and phosphorus in urine, for example.
Radiographic exams can also help to identify the disease, as it demonstrates bones with demineralization and osteoporosis. In the most advanced cases, this test can show the formation of excavations and proliferation of tissues and vessels in the bones, which is known as a "brown tumor".
In addition, image exams of the neck region, with ultrasound, scintigraphy or magnetic resonance, for example, can help to identify changes in parathyroid glands.
How the treatment is done
The first step in the treatment of primary hyperparathyroidism is the correction of calcium levels, which, if they are very altered, can be the main cause of symptoms. For this, there are a few different options, including hormone replacement, made especially in women after menopause, as the replacement of some hormones helps to maintain calcium levels in the bones. Bisphosphonate drugs, on the other hand, also help to increase the deposition of calcium in the bones, decreasing the free calcium in the blood. Check out other causes of excess calcium in the blood and how to treat it.
Surgery can also be indicated in the case of primary hyperparathyroidism, as it removes the affected glands, curing the disease. However, it has some risks such as damage to the nerves that control the vocal cords or a marked decrease in calcium levels.
In the case of secondary hyperparathyroidism, it is necessary to do the correct monitoring and treatment of renal failure, replacement of vitamin D and calcium levels, which are reduced. Calcimimetic remedies have a similar effect to calcium, causing the glands to produce less hormones. An example of these remedies is cinacalcete.
